Veterinary Medicine - November 2008 - (Page PD10)

Table 1. Phrases to use with clients Here are some examples of phrases to use with clients to emphasize the importance of prevention: “Fleas probably aren’t Skipper’s problem; however, ﬂeas still aren’t his friend. His itch is severe already, imagine how much worse it would be if he got ﬂeas too.” “We are doing this to ﬁgure out why Skipper is itchy. Getting ﬂea bites in the middle of the food trial would really confuse the situation. Let’s make sure that can’t happen.” “Let’s control what we can so we can narrow down the possibilities of what is making Skipper itch. We can’t control pollen, but we can control ﬂeas!” “Usually people are bitten by newly hatched ﬂeas. By the time you get bit, you have an infestation. It’s much easier to prevent ﬂeas now than to eliminate ﬂeas later.” and nitenpyram. Because of a short duration of action, nitenpyram should be repeated as often as one time daily or administered in combination with other products. Perceived treatment failure is more likely due to newly emerged fleas than from resistance to the product. Even when on-patient therapy is effective, owners may observe occasional adult ﬂeas. This is usually due to newly emerged adult ﬂeas from the environment rather than treatment failure or product resistance. True resistance is rare. Environmental ﬂea burdens are heavier in multiple pet households or yards with feral ﬂea carriers, such as possums or raccoons; this can result in ongoing exposure to newly emerged ﬂeas for ﬂea allergic pets. Therefore additional environmental control targeting all life stages becomes a necessary component of comprehensive ﬂea control. If seeing a single live ﬂea would cause owner to lose trust or perceive failure, adding a rapid kill adulticide, such as nitenpyram, spinosad, or dinotefuran may be desirable, in addition to environmental treatment. To obtain the ideal of rapid kill, long duration, systemic distribution, and miticidal activity, combining multiple products, such as selemectin for safe and effective broad mite and ﬂea management with dinotefuran, nitenpyram, or spinosad for rapid ﬂea kill can be useful in certain circumstances. Consult the manufacturer for safety and compatibility with other products if combination therapy is necessary. can be dire, all patients on high-dose ivermectin should be either tested for the multidrugresistance (MDR) 1 mutant gene or given lower doses first. If owners observe signs of neurotoxicity (ataxia, mydriasis, tremors, obtundation) at lower doses, discontinue therapy. Rather than risking a toxic event or using valuable consultation time discussing ivermectin toxicosis, the author recommends avoiding routine use of ivermectin for parasite treatment trials when there are safe, effective, and FDAapproved alternatives readily available. Relay to clients that comprehensive ﬂea control is essential for all pruritic patients. Focus on prevention rather than treatment when talking to owners who may be reluctant to implement ﬂea control. In addition to miticidal therapy, institute aggressive ﬂea control early in management of all pruritic patients, even if ﬂeas cannot be demonstrated. Convincing clients to implement ﬂea control can be challenging; however, you must deﬂect common objections and stress to owners that comprehensive ﬂea control is in their best interest (see Table 1). You can improve compliance in this area by focusing on prevention rather than treatment. By doing this, you not only successfully convince owners to accept a treatment trial to rule out occult parasitism, but also establish the importance of ongoing ﬂea prevention in managing of other causes of pruritus. Patients with atopic dermatitis are usually much worse with ﬂea infestation, therefore ongoing ﬂea prevention is an important part of an ideal management plan. Veterinarians have many products available. Selection depends on each speciﬁc situation. For example, in atopic patients, if frequent bathing is recommended to manage secondary skin infections or reduce absorption of environmental allergens across the skin, use systemic ﬂea products that cannot be washed off. Examples include selamectin, spinosad, 10 PRACTICAL DERMATOLOGY FOR THE BUSY PRACTITIONER

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Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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